Loperamide is the only over the counter opiate (That I know of in the United States. Might be others, don't know.) It is marketed as Imodium and used for as an antidiarrheal. There are currently no "over the counter" drugs that contain opiates or opioids. Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy, Papaver Somniferum. The major biologically active opiates found in opium are morphine, codeine, thebaine and papaverine. Synthetic opioids such as heroin and hydrocodone are derived from these substances, especially morphine and codeine. Noscapine, narceine and approximately 25 other alkaloids are also present in opium, but have little to no effect on the human central nervous system, and are not usually considered to be opiates. Opium is mostly produced in Asia.

The sole clinical indications for opioids in the United States, according to Drug Facts and Comparisons, 2005, are:

* Analgesia i.e. to combat pain of various types and induction and the continuance of anesthesia as well as allaying patient apprehension right before the procedure. Fentanyl, oxymorphone, hydromorphone, and morphine are most commonly used for this purpose, in conjunction with other drugs such as scopolamine, short and intermediate-acting barbiturates, and benzodiazepines, especially midazolam which has a rapid onset of action and lasts shorter than diazepam or similar drugs. The combination of morphine (or sometimes hydromorphone) with alprazolam or midazolam or other similar benzodiazepines with or without scopolamine (rarely replaced with or used alongside Compazine®, Zofran® or other anti-nauseants) is coloquially called "Milk of Amnesia" amongst anesthesiologists, hospital pharmacists, physicians, radiologists, patients and others. The enhacement of the effects of each drug by the others is useful in troublesome procedures like endoscopies, complicated and difficult deliveries (pethidine and its relatives and piritramide where it is used are favoured by many practitioners with morphine and derivatives as the second line), incision & drainage of severe abcesses, intraspinal injections, and minor and moderate-impact surgical procedures in patients unable to have general anesthesia due to allergy to some of the drugs involved or other concerns.

* Cough (codeine, dihydrocodeine, ethylmorphine (dionine), hydromorphone and hydrocodone, with morphine or methadone as a last resort.)

* Diarrhoea (generally loperamide, difenoxin or diphenoxylate, but paregoric, powdered opium or laudanum or morphine may be used in some cases of severe diarrheal diseases)

* Diarrhoea of Irritable Bowel Syndrome (Codeine, paregoric, diphenoxylate, difenoxin, loperamide, laudanum)

* Anxiety due to shortness of breath (oxymorphone and dihydrocodeine only)

* Detoxification (methadone and buprenorphine only)

In the U.S., doctors virtually never prescribe opioids for psychological relief (with the narrow exception of anxiety due to shortness of breath), despite their extensively reported psychological benefits, and the widespread use of opiates in depression and anxiety up until the mid 1950s. There are virtually no exceptions to this practice, even in circumstances where researchers have reported opioids to be especially effective and where the possibility of addiction or diversion is very low-for example, in the treatment of senile dementia, geriatric depression, and psychological distress due to chemotherapy or terminal diagnosis (see Abse; Berridge; Bodkin; Callaway; Emrich; Gold; Gutstein; Mongan; Portenoy; Reynolds; Takano; Verebey; Walsh; Way).

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